How can Practices Avoid Losing Money

For a medical practice, collecting copays, deductibles, and coinsurance is essential to avoiding revenue loss. In healthcare revenue cycle management (RCM), collecting payments from patients properly reduces the risk to your business. Better RCM means having the funds available for continuous improvement and progress in office systems, the facility, and employees, which will aid in the productivity of the practice, for example – improved confidence among team members, financial resource availability to purchase newer equipment for your practice. Decreased staff turnover and better facilities will contribute to better quality and continuity of care. To reap these benefits, healthcare providers should follow a few steps to avoid losing money on uncollected payments.

Process Patient Financial Responsibility Immediately

Staff should obtain all patient insurance cards at each visit, and they should ask patients to sign a confirmation page validating entered details. The routine paperwork for check-in should also include a note explaining payment expectations. Getting information in the system faster enables the front office to begin the claims’ process immediately.

Collect Copays at the Time of Service

Patients with insurance will need to pay the copay at the time of service prior to seeing a provider. Commercial insurance cards contain copayment insurance information for the type of provider, but certain services, such as urgent care and specialists, may incur a higher copay that will be evident upon submitting insurance information. A brief explanation of the copays to patients and collect them at the time of check-in.

Advise Patients of Their Remaining Deductibles

Patients expect to be notified of higher costs for a visit as soon as possible. Although they may already know their current deductible status, staff should validate the information with the insurer. This helps everyone understand the total cost for the visit. Furthermore, knowing the deductible can help patients plan for follow-up care, including prescription drug costs and repeat visits.

Collect Billed Amounts Following Service and Before Patients Leave

After seeing a provider, coinsurance or additional charges that do not yet meet the deductible prior to patient departure should be collected. If a procedure is required that would incur additional charges, office staff should inform the patient prior to completing procedures. Keeping the patient in the loop of total costs will reduce the “surprise” of unexpected costs after seeing a provider. In addition, it helps to avoid unnecessary payment arrangements.

Work With Patients to Develop Automated Payment Plans

Issues may arise requiring urgent treatment, and these problems may incur additional costs that would otherwise be billed later. This may include charges applicable to the deductible or even coinsurance. In such cases, the healthcare provider may be required to see a patient regardless of the ability to pay or transfer the patient to an emergency center. However, it is still possible to avoid uncollected payments by working with patients to develop a payment plan. An even better solution is to create a payment plan with automated drafts to a bank account, credit card, or debit card. Automatic payments eliminate all uncertainty regarding expected payments and reduce the risk of lost charges.

Track Claims Thoroughly

Health insurers may take time in processing claims, including paying partial payments pending review of the electronic health record (EHR). While it is impractical to try to collect on services rendered while the claims’ process continues, staff should track claims thoroughly. Any requests for documentation should be submitted as soon as possible, and when payment complete, staff should follow through with subsequent billing to patients for the remainder.

Identify Missed Revenue

Declining reimbursement among commercial insurers and government payers places an additional burden on healthcare providers. Providers should work to identify under-reimbursed claims and ensure medical coding and billing accuracy.

Ensure Staff Knows How to Navigate and Use the EHR

Time is of the essence in medical billing. Lost time spent trying to enter patient insurance information or treatment details within the EHR will result in billing delays. Such action may lead to patients leaving a facility before knowing whether the payer authorized payment or if a coinsurance payment was necessary. Staff should complete regular, thorough training sessions to learn how to use the EHR. All EHR details should be entered and submitted for claims’ processing before the end of the visit.

Implement an EHR That Includes Billing Capabilities

Utilizing a billing capability-inclusive EHR further reduces errors in submitting claims and streamlines the process. Since staff only need to learn a single system, human entry error rates decrease, and accuracy in billing will increase. Moving to a billing-capable system may also be more cost-effective to maintain and implement than managing multiple systems.

Choose a High-Quality EHR to Enhance Healthcare RCM

A high-quality EHR will help your practice provide better care and avoid unnecessary financial loses. Therefore, PrognoCIS RCM tools are integrated with the EHR to maximize billing accuracy and RCM tracking. Additional key functions of PrognoCIS RCM include maximizing billing accuracy, run custom reports to understand finances, check state, specialty and practice billing guidelines, follow up with health insurers regarding claims’ underpayments, and include a dedicated RCM client services manager to consistently help you with your needs and requirements. This is in addition to an efficient collection rate and our exceptional first pass claim acceptance rates. Find out how better RCM practices via PrognoCIS could contribute to your practices bottom-line by requesting a free, custom medical billing analysis today. 

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